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One Alternative: A Ring That Squeezes the Stomach

Ben Zuckerman, a 57-year-old bottling executive from King of Prussia, Pa., was not surprised last year to find himself carrying more than 290 pounds on his 6-foot-1 frame. Mr. Zuckerman said he could look back on decades of binge eating and failed diets.

But he was worried about the onset of health problems often linked to obesity, like the potentially lethal nighttime interruptions in breathing known as sleep apnea. "I told myself it was crazy and I was killing myself," Mr. Zuckerman said.

Still, he could not bring himself to face the risks, pain and slow recuperation that come with what is generally regarded as the most effective obesity treatment doctors have to offer -- bariatric surgery to shrink the stomach's capacity and bypass the upper intestine. Instead, he opted last month to travel to Lenox Hill Hospital in New York for a simpler surgery that implanted an inflatable silicone ring around his stomach.

The Lap-Band, as the device is called, squeezes Mr. Zuckerman's stomach into a bottom-heavy hourglass shape with an upper pouch about the size of a walnut. Filling the pouch stimulates nerves that create a sensation of fullness. The small opening to the lower stomach slows digestion to delay the onset of new hunger pangs.

Bariatric surgery patients lose more weight on average but research has shown that many Lap-Band patients manage gradually to shed 50 percent of their excess weight. Lap-Band patients can suffer a variety of side effects, including hoarseness, vomiting, acid reflux and nausea. One study published last year concluded that around 6 percent of patients lose no weight or have complications forcing them to have the device removed. Those who fail often undermine themselves by consuming high-calorie drinks that slip rapidly through the upper pouch.

"Once I made up my mind to do it, I would have gone ahead even if the insurance hadn't been approved," Mr. Zuckerman said.

Since Lap-Band procedures are being billed at anywhere from $15,000 to $40,000 by hospitals in various parts of the country -- Mr. Zuckerman's was $31,500 -- that kind of talk makes a strong impression on device makers.

In the last few years, medical device companies from start-ups to giants like Medtronic and Johnson & Johnson have concluded that the obesity market is too inviting to leave to drug makers, diet mavens and traditional surgeons.

The Lap-Band is currently the only medical device approved by the Food and Drug Administration to treat obesity, but similar internal cinches already compete with it overseas. And a variety of other devices are in the pipeline, including variations on heart pacemakers that use electrical signals to modify the digestive system.

"Obesity is a multi-hundred-billion-dollar market ready and waiting for device developers to catch up with an enormous unmet need," said Mary Stuart, author of a 2003 research report in Start-Up, a review of emerging markets published by Windhover Information.

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It is hard to put much faith, though, in such market projections for obesity devices. Device companies have built large businesses by focusing on organs like the heart and on major joints, where research and widespread use of surgery have led to a deep knowledge of the medical issues.

"The basic science of digestion and the fat cycle is not as well understood," said Dr. Thomas J. Fogarty, a professor at the Stanford University School of Medicine. That limited knowledge is a major barrier for anyone trying to design a pacemaker for the stomach or the major nerves that connect it to the brain.

"The right wiring is in place to communicate with the brain, but we really don't know the language yet," said Dr. Mitchell Roslin, the Lenox Hill stomach specialist who inserted Mr. Zuckerman's Lap-Band and has also experimented with pacemakers.

That leaves stomach-banding products as the device industry's best near-term bet. Lap-Band sales are surging despite the still limited number of doctors trained to implant it and the refusal of most insurers to pay for it. Its maker, Inamed, based in Santa Barbara, Calif., reported that its worldwide sales of obesity devices -- nearly all Lap-Bands -- grew at 40 percent last year, to more than $88 million.

Lap-Band is made under a license from Johnson & Johnson. But that medical giant's Ethicon Endo-Surgery division is looking to compete with a different band made in Sweden. Johnson acquired rights to the Swedish band when it bought Obtech Medical, the company that sells it overseas, for an undisclosed sum in 2002.

Lap-Band accounted for 11 percent of anti-obesity operations last year, according to the American Society of Bariatric Surgeons. The rate is considerably higher in the New York area, where more than 100 surgeons have been trained to install it, according to Inamed. One leader in the field, Dr. George A. Fielding of the New York University Medical Center, underwent the procedure himself in 1999.

The band's advantages over bypass surgery are that the risk of death or serious complications is about one-tenth as much and that it is easily adjustable and reversible. That makes it attractive for women who may want to become pregnant and increase their food intake at some point.

Less invasive surgery also leads to quicker recoveries in most cases. Mr. Zuckerman had his surgery on Friday, April 8, returned home the next day and was fit enough to return to work the following Monday. Now, six weeks later and 26 pounds lighter, he returned yesterday to Lenox Hill to have the Lap-Band inflated enough to stimulate further weight loss.

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A version of this article appears in print on May 27, 2005, on Page C00002 of the National edition with the headline: One Alternative: A Ring That Squeezes the Stomach. Order Reprints|Today's Paper|Subscribe